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Edwin Anders, Heather Hancock, Danielle Williamson, Daniel McGuffey, Ching Jygh Chen; Visual Acuity and Optical Coherence Tomography Findings after Vitrectomy with Double Membrane Peel for Treatment of Epimacular Membrane. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2812.
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To assess long-term postoperative outcomes of visual acuity and OCT findings in patients who received pars plana vitrectomy (PPV) and double peel of epimacular membrane (EMM) and internal limiting membrane for treatment of EMM.
A retrospective chart review of 65 EMM patients (42 pseudophakic and 23 phakic) who underwent PPV and double membrane peel by a single surgeon was performed. Complete eye examination data and OCT findings were collected for statistical analysis. OCT images were assessed for central foveal thickness (CFT), foveal contour (FC), retinal folds (RF), macular edema (ME), lamellar macular hole (LMH) and tractional schisis (TS). In the phakic group, we also assessed pre- and postoperative lens status, need for lens extraction following EMM surgery, and best corrected vision after cataract extraction.
Among 65 patients, 42 were pseudophakic (Group 1) and 23 were phakic (Group 2). Average follow up was 403 days in group 1 and 440 days in group 2. Best LogMAR vision in group 1 was 0.42 pre-operatively (Pre-op) and 0.21 postoperatively (Post-op). In group 2, 78.3% showed vision deterioration due to worsening of cataract. 21 of 23 patients (91.3%) required cataract extraction. Best corrected vision in group 2 was 0.45 Pre-op and 0.09 Post-op (after EMM and cataract extraction). OCT findings in group 1: Pre-op CFT - 446.87 µm and Post-op CFT - 372.89 µm (Mean reduction: 73.98 µm). Only 2.4% of FC returned to fully normal after surgery. 88.1% of RF improved and 69.1% of ME reduced postoperatively. Pre-op LMH (11.9%) and TS (2.4%) resolved completely after surgery. OCT findings in group 2: Pre-op CFT - 468.39 µm and Post-op CFT - 380.43 µm (Mean reduction: 87.96 µm). 17.4% of FC returned to fully normal. 91.3% of RF improved and 60.9% of ME reduced postoperatively. Pre-op LMH (8.7%) and TS (4.3%) resolved completely after surgery. Retinal detachment was found in one patient. No EMM recurrence was noted.
PPV with double membrane peel is a safe and effective treatment for EMM. It is likely to stabilize or improve the vision and reduce the recurrence after the surgery. It often results in reduction of CFT, RF, ME, closure of LMH and relief of TS. Foveal contour tends to improve but rarely returns to fully normal postoperatively.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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